Psychoanalysis as Therapy and Story Telling (Book Review)

This is the first of Antonino Ferro’s many contributions to the psychoanalytic literature that I have (as yet) read and I found it a wonderful book. I mention my limited experience with his oeuvre at the outset by way of a disclaimer: I may very well fail to capture some points or even distort, albeit inadvertently, Ferro’s meaning or intent, for which I apologize in advance. I would label myself as a contemporary Freudian who is attempting to educate myself with regard to other recent developments in psychoanalytic thinking.

Shortly, I will invite the reader of this review to follow along with me through my understanding of what this book discusses. I want first, however, to comment on the most exciting feature to me of Psychoanalysis as Therapy and Story Telling: Ferro’s clinical examples. Over and over, he presents succinct but vivid examples of his interactions with a given patient, accompanied by his assessments of what had transpired. These seem not only creative but accurate, capturing apt meanings that make sense, and inducing in the reader a feeling of pleasure at the imaginative “take” on the material. I felt I was in the presence of a master clinician. I was impressed regardless of the extent of my acceptance of Ferro’s overall point of view. Thus, though there is much to consider of value in this book, solely reading his vignettes/assessments is enormously worthwhile. (It is a puzzling but repeated observation that I find resonance with the clinical work of seasoned analysts from many schools of analytic thought different from my own, as if the experience of clinical psychoanalysis itself is the common denominator for many of us.)

In Chapter One, Ferro lays out his basic tenets, which he then weaves into all the chapters, reworking his ways of stating them so that they become increasingly clear to the reader. While acknowledging the many ways that the term “narration” is used, he describes his own particular definition as “ . . . way of being in the session whereby the analyst shares with the patient in the ‘construction of a meaning’ . . . [called] transformational co-narration [which] takes the place of interpretation” (p. 1). It is, thus, “the offspring of the minds of both.” Primarily relying on Bion’s concepts of beta elements and undigested facts that get transformed into alpha functioning and the ability to think thoughts through providing a setting of containment of oscillating paranoid and depressive anxieties (originally from Klein’s work), Ferro builds a picture of the analyst as focused on entering the patient’s “world,” rather than focused on interpretation which would only serve the analyst’s own narcissism and be an unwelcome intrusion—or worse—for any patient whose alpha function, that is, ability to think, is not optimal. He says that one can only treat the disease if you “get” the disease, which is another way of saying that you can only understand from the inside of the experience -- even though Ferro realizes that “the analytic situation necessarily involves a degree of asymmetry because the analyst is responsible for the progress of the” (p. 7) work. A Freudian might call that “trial identification.”

Ferro adds that his is a “field theory” in which the psychoanalytic session is the field in which the analysis proceeds. While noting other interpretive points of view—such as the analyst listening as if the people and events described could be understood in the Freudian manner as real historical/genetic references or as a decoding of unconscious bodily fantasy from a Kleinian perspective—Ferro stresses:

"The limit of the possible stories is only that they should as far as possible arise from the transference (understood as repetition and the projection of fantasies) and from the patient’s emotions . . . [The analyst’s understanding of these stories] should not therefore serve for confirmation of the analyst’s theories." (p. 10)

The point he is emphasizing is the unsaturated nature of the analyst’s position, that is, not preformed or preconceived but open to possibility. Further, that “the field coincides with the narration . . . which is already out of date at the very moment when it is completed,” thus making it a fluid field (p. 11). Again, the characters in the narration are simultaneously historically real characters (Freud’s view), referencing internal objects of the patient’s inner world (Klein’s view); but for Ferro these genetic and intrapsychic aspects are put aside to pay attention to the analytic field and the “quality of functioning of the couple in the field” (p. 14).
Moreover, as amply demonstrated in Ferro’s clinical examples, the analyst’s function is to follow and enhance the development of meaning that the patient signals through the characters brought on stage in order to understand what is happening between analyst and patient in the session (in the transference).

This is a transformative process that helps the patient increasingly tolerate his affects and thoughts but can easily be disrupted if the analyst overestimates the patient’s capacity to hear the analyst’s take on the current transference implications of the narration. At such times, the analyst will hear the “violence” done to the containment function that has occurred by listening to the verbal, nonverbal behavior, or acting out responses of the patient. When the analyst understands his failure and acknowledges the part he has played in creating the violence, the field can return to the transformative mode, the analyst having made the field less persecutory. The analyst is thus invited to hold a delicate balance, participating in such a way as to continually further the sense of the meaning without overreaching, and waiting for the most propitious moment to conceptualize a transference observation to the patient.

In some ways this conceptualization of the process is reminiscent of a self psychological description of attunement and failures of attunement, and a Freudian one of the effects of a “break in the frame,” and provides the opportunity for working through of such moments when the analyst takes responsibility for his limitations, errors, or narcissistic attachment to his theories. Ferro, however, thinks of it more in terms of saturated and unsaturated interventions. Saturated refers to comments that have an agenda and are filled with the theoretical preconceptions of the analyst; whereas unsaturated avoids foreclosure and leaves the possibility open for the patient to choose his own path. As an outgrowth of Ferro’s genuine capacity to develop his own psychoanalytic path, he has found a way of working with, understanding, and helping to heal even the most disturbed patients.

To return for a moment to Ferro’s discussion of “acting out,” he uses the concept in a way consistent with his field theory; yet few analysts would disagree. For Ferro, “acting out [is] a signal of a dysfunction of the field, which, however, contains within itself the possibility of communication, if it is received and transformed into thought” (p. 98).

While there are many other aspects of his thinking that are important, two may be of particular interest. One has to do with implications for drive theory, in particular, the role of infantile sexuality in Ferro’s articulation of his point of view. The other has to do with a central tenet of many contemporary points of view, namely, countertransference.

Ferro devotes a chapter to his conception of the role of sexuality in the consulting room. He is quick to give credit to Freud and to later analysts for “enormous contributions to our knowledge of human sexuality” (p. 37). However, he considers reference to sexuality beside the point, as a defensive “avoidance of depressive experiences” (p. 41), for example, or merely one of the characters (since characters can be people or objects or even processes) in the analytic field that one might contemplate on the way to understanding the meaning of the thoughts the patient and analyst are trying to digest in the session that has to do with the relationship between the analytic couple. He seems to favor a way of thinking of sexuality in the sense of the mating of two minds.

The examples Ferro gives to demonstrate moments when obviously sexual material is in the field and how it can best be dealt with as providing relational meaning rather than erotic are very convincing but do also bring to mind that there are, to use a well-worn metaphor, many roads to Rome. Obviously, the analyst may not go down paths that lead in different directions at the same time—a phenomena often exemplified by the way analysts in a case conference “hear” different meanings of the presenter’s material that would take the session in another direction from the one chosen. If a road is taken consistently and effectively, there is analytic evidence to suggest that the approach will be successful even though other aspects, even of significance, may not be touched. My only reservation would be a concern that inadvertently there might be an avoidance in the analyst that could be theoretically or countertransferentially (as in the analyst’s transference) based, something Ferro himself would clearly not advocate.

Countertransference, as used in the previous sentence, is obviously not the primary way that countertransference is understood these days, when the emphasis is more broadly understood in terms of what the countertransference of the analyst allows the analyst to learn about the patient. While Ferro explains that he used to be very attentive to the countertransference, he now feels that listening to the field signals can preempt countertransference altogether. He acknowledges “the countertransference—like a useful episode of indigestion—signals that the field is permeated with â-elements, which it has not been possible for the analyst’s á-function to transform into á” (p. 101). To put it another way, Ferro states,

The attention formerly devoted to observing the patient’s communications and the countertransference now becomes attention to the figures that take shape in the field . . all the “obscure” emotional events that used to be picked up by the countertransference are now usually—before activating countertransference manifestations—signaled by the field, provided that the analyst is able to listen to the narrations of the session as forming part of the current field. (p. 100)

This view of countertransference presents a picture of it as a useful tool only as a last resort when the field is already in a dysfunctional state. The capacity to anticipate from the signals in the field, while admirable, may be more of an ideal than a practice for many analysts less skilled than Ferro. Yet, Ferro himself shares how challenging such a stance is, when he offers his amazingly open and self-revealing descriptions of his own earlier analytic efforts, which he now sees more clearly as examples of a dysfunctional field. That openness, too, is an ideal to admire!

In closing, I want to express again how much I value this opportunity to learn from Antonino Ferro. I am eager to read more of his work, and I strongly recommend such exploration to all those interested in psychoanalytic thought no matter what their own persuasion.